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Bevacizumab for radiation necrosis following treatment of high grade glioma: a systematic review of the literature

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Abstract

This review identifies the current literature on the use of bevacizumab for cerebral radiation necrosis in patients with high-grade gliomas, summarizes the clinical course and complications following bevacizumab, and discusses the relative costs and benefits of this therapeutic option. A Medline search was conducted of all clinical studies before September 2012 investigating outcomes following use of bevacizumab therapy for radiation necrosis in patients with high-grade gliomas. Clinical and radiographic outcomes are reviewed. Seven studies reported a total of 30 patients with high-grade gliomas treated with bevacizumab for radiation necrosis. All patients demonstrated decreased radiographic volume of edema on T1 and T2 MRI sequences. Clinical outcomes were reported for 23 patients: 16 (70 %) had improvement in neurologic signs or symptoms, 5 (22 %) had mixed results, and 2 (9 %) remained neurologically unchanged. Complications were documented in 5 of 7 studies (18 of 29 patients, 62 %) and included deep vein thrombosis, pulmonary embolism, visual field worsening, worsening hemiplegia, pneumonia, seizure, and fatigue. Only one study evaluated quality of life measures and none evaluated cost or cost effectiveness. Data regarding the use of bevacizumab to treat radiation necrosis in patients with high-grade gliomas is limited and primarily class III evidence. While bevacizumab improves neurological symptoms and reduces radiographic volume of necrosis-associated cerebral edema, it comes at the expense of a high rate of potentially serious complications. Definitive evidence for the utility, cost-effectiveness, and overall efficacy of this management strategy is currently lacking and additional investigation is warranted.

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The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave NA21, Cleveland, OH, 44195, USA

    Daniel Lubelski & Robert J. Weil

  2. Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave ND40, Cleveland, OH, 44195, USA

    Daniel Lubelski & Robert J. Weil

  3. Department of Neurological Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA

    Kalil G. Abdullah

  4. Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave ND40, Cleveland, OH, 44195, USA

    Robert J. Weil

  5. Department of Neurosurgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    Nicholas F. Marko

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  1. Daniel Lubelski
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  2. Kalil G. Abdullah
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  4. Nicholas F. Marko
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Correspondence to Nicholas F. Marko.

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Lubelski, D., Abdullah, K.G., Weil, R.J. et al. Bevacizumab for radiation necrosis following treatment of high grade glioma: a systematic review of the literature. J Neurooncol 115, 317–322 (2013). https://doi.org/10.1007/s11060-013-1233-0

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  • DOI: https://doi.org/10.1007/s11060-013-1233-0

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